Skip to main content
Top
Published in: Sports Medicine 9/2016

01-09-2016 | Systematic Review

School-Based Interventions to Improve Cardiorespiratory Fitness in Adolescents: Systematic Review with Meta-analysis

Authors: Giseli Minatto, Valter Cordeiro Barbosa Filho, Juliane Berria, Edio Luiz Petroski

Published in: Sports Medicine | Issue 9/2016

Login to get access

Abstract

Background

School-based intervention can contribute to the promotion of cardiorespiratory fitness (CRF) in adolescents. However, it is neces sary to systematize how intervention strategies and the methodological characteristics of studies influence the effects of CRF interventions.

Objective

A meta-analysis review of school-based intervention studies aimed at increasing CRF in adolescents (10–19 years of age) was conducted.

Methods

A search for studies was conducted using the Medline, Web of Science, LILACS, PsycINFO, Embase, Scopus, SPORTDiscus and Cochrane databases and the reference lists of the selected studies. The peer selection process included consideration of school-based randomized or non-randomized controlled trials with a duration ≥12 weeks published in English, Portuguese or Spanish, and with some CRF measures. The methodological quality of the studies was also assessed. The standardized mean differences (SMDs) and 95 % confidence intervals (95 % CIs) were calculated as an effect measure.

Results

Forty publications of 30 interventions were included in the review, and 25 of these were meta-analysed. The effects of CRF interventions were moderate and significant (SMD = 0.68, 95 % CI 0.45–0.90), with high heterogeneity (I 2 = 97 %). The effect size varied significantly according to the age group, sample size, intervention environment, strategies in experimental groups, CRF priority in the study, CRF test and indicator, session length, weekly frequency, intervention duration and presentation of results by sex.

Conclusion

Interventions in the school environment seem to have a positive effect on CRF among adolescents, but there is high heterogeneity between studies. Some intervention characteristics can explain better effects on CRF (e.g. exercise sessions in addition to physical education classes; primary focus on this outcome; combination of aerobic and resistance exercises; classes lasting ≥60 min; frequency of three times weekly; and intensity control).
Appendix
Available only for authorised users
Literature
1.
go back to reference Ortega FB, Ruiz JR, Castillo MJ, et al. Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes. 2008;32(1):1–11.CrossRef Ortega FB, Ruiz JR, Castillo MJ, et al. Physical fitness in childhood and adolescence: a powerful marker of health. Int J Obes. 2008;32(1):1–11.CrossRef
3.
go back to reference Dwyer T, Magnussen CG, Schmidt MD, et al. Decline in physical fitness from childhood to adulthood associated with increased obesity and insulin resistance in adults. Diabetes Care. 2009;32(4):683–7. doi:10.2337/dc08-1638.CrossRefPubMed Dwyer T, Magnussen CG, Schmidt MD, et al. Decline in physical fitness from childhood to adulthood associated with increased obesity and insulin resistance in adults. Diabetes Care. 2009;32(4):683–7. doi:10.​2337/​dc08-1638.CrossRefPubMed
5.
go back to reference Martinez-Gomez D, Ortega FB, Ruiz JR, et al. Excessive sedentary time and low cardiorespiratory fitness in European adolescents: the HELENA study. Arch Dis Child. 2010;7(6):746–53. doi:10.1136/adc.2010.187161. Martinez-Gomez D, Ortega FB, Ruiz JR, et al. Excessive sedentary time and low cardiorespiratory fitness in European adolescents: the HELENA study. Arch Dis Child. 2010;7(6):746–53. doi:10.​1136/​adc.​2010.​187161.
6.
go back to reference Pelegrini A, Silva DAS, Petroski EL, et al. Aptidão física relacionada à saúde de escolares brasileiros: dados do projeto esporte Brasil. Rev Bras Med Esporte. 2011;17(2):92–6.CrossRef Pelegrini A, Silva DAS, Petroski EL, et al. Aptidão física relacionada à saúde de escolares brasileiros: dados do projeto esporte Brasil. Rev Bras Med Esporte. 2011;17(2):92–6.CrossRef
8.
go back to reference Bayne-Smith M, Fardy PS, Azzollini A, et al. Improvements in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: the PATH program. Am J Public Health. 2004;94(9):1538–43.CrossRefPubMedPubMedCentral Bayne-Smith M, Fardy PS, Azzollini A, et al. Improvements in heart health behaviors and reduction in coronary artery disease risk factors in urban teenaged girls through a school-based intervention: the PATH program. Am J Public Health. 2004;94(9):1538–43.CrossRefPubMedPubMedCentral
9.
go back to reference Bonhauser M, Fernandez G, Püschel K, et al. Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Health Promot Int. 2005;20(2):113–22.CrossRefPubMed Bonhauser M, Fernandez G, Püschel K, et al. Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Health Promot Int. 2005;20(2):113–22.CrossRefPubMed
10.
11.
go back to reference Christiansen LB, Toftager M, Boyle E, et al. Effect of a school environment intervention on adolescent adiposity and physical fitness. Scand J Med Sci Sports. 2013;23(6):381–9. doi:10.1111/sms.12088.CrossRef Christiansen LB, Toftager M, Boyle E, et al. Effect of a school environment intervention on adolescent adiposity and physical fitness. Scand J Med Sci Sports. 2013;23(6):381–9. doi:10.​1111/​sms.​12088.CrossRef
13.
go back to reference Dunton GF, Schneider M, Cooper DM. An investigation of psychosocial factors related to changes in physical activity and fitness among female adolescents. Psychol Health. 2007;22(8):929–44. doi:10.1080/14768320601124915.CrossRef Dunton GF, Schneider M, Cooper DM. An investigation of psychosocial factors related to changes in physical activity and fitness among female adolescents. Psychol Health. 2007;22(8):929–44. doi:10.​1080/​1476832060112491​5.CrossRef
14.
go back to reference Dwyer T, Coonan WE, Leitch DR, et al. An investigation of the effects of daily physical activity on the health of primary school students in South Australia. Int J Epidemiol. 1983;12(3):308–13.CrossRefPubMed Dwyer T, Coonan WE, Leitch DR, et al. An investigation of the effects of daily physical activity on the health of primary school students in South Australia. Int J Epidemiol. 1983;12(3):308–13.CrossRefPubMed
15.
go back to reference Farias ES, Carvalho WRG, Gonçalves EM, et al. Efeito da atividade física programada sobre a aptidão física em escolares adolescentes. Rev Bras Cineantropom Desempenho Hum. 2010;12(2):98–105. Farias ES, Carvalho WRG, Gonçalves EM, et al. Efeito da atividade física programada sobre a aptidão física em escolares adolescentes. Rev Bras Cineantropom Desempenho Hum. 2010;12(2):98–105.
16.
go back to reference Flores R. Dance for health: improving fitness in African American and Hispanic adolescents. Public Health Rep. 1995;110(2):189–93.PubMedPubMedCentral Flores R. Dance for health: improving fitness in African American and Hispanic adolescents. Public Health Rep. 1995;110(2):189–93.PubMedPubMedCentral
18.
go back to reference Halfon S-T, Bronner S. The influence of a physical ability intervention program on improved running time and increased sport motivation among Jerusalem schoolchildren. Adolescence. 1988;23(90):405–16.PubMed Halfon S-T, Bronner S. The influence of a physical ability intervention program on improved running time and increased sport motivation among Jerusalem schoolchildren. Adolescence. 1988;23(90):405–16.PubMed
22.
go back to reference Kain J, Uauy R, Albala, et al. School-based obesity prevention in Chilean primary school children: methodology and evaluation of a controlled study. Int J Obes. 2004;28(4):483–93. doi:10.1038/sj.ijo.0802611.CrossRef Kain J, Uauy R, Albala, et al. School-based obesity prevention in Chilean primary school children: methodology and evaluation of a controlled study. Int J Obes. 2004;28(4):483–93. doi:10.​1038/​sj.​ijo.​0802611.CrossRef
24.
go back to reference Knox GJ, Baker JS, Davies B, et al. Effects of a novel school-based cross-curricular physical activity intervention on cardiovascular disease risk factors in 11- to 14-year-olds: the activity knowledge circuit. Am J Health Promot. 2012;27(2):75–83. doi:10.4278/ajhp.110617-QUAN-258.CrossRefPubMed Knox GJ, Baker JS, Davies B, et al. Effects of a novel school-based cross-curricular physical activity intervention on cardiovascular disease risk factors in 11- to 14-year-olds: the activity knowledge circuit. Am J Health Promot. 2012;27(2):75–83. doi:10.​4278/​ajhp.​110617-QUAN-258.CrossRefPubMed
25.
go back to reference Lindgren EC, Baigi A, Apitzsch E, et al. Impact of a six-month empowerment-based exercise intervention programme in non-physically active adolescent Swedish girls. Health Educ J. 2011;70(1):9–20. doi:10.1177/0017896910379366.CrossRef Lindgren EC, Baigi A, Apitzsch E, et al. Impact of a six-month empowerment-based exercise intervention programme in non-physically active adolescent Swedish girls. Health Educ J. 2011;70(1):9–20. doi:10.​1177/​0017896910379366​.CrossRef
26.
go back to reference Perry AC, Rosenblatt ES, Kempner L, et al. The effects of an exercise physiology program on physical fitness variables, body satisfaction, and physiology knowledge. J Strength Cond Res. 2002;16(2):219–26.PubMed Perry AC, Rosenblatt ES, Kempner L, et al. The effects of an exercise physiology program on physical fitness variables, body satisfaction, and physiology knowledge. J Strength Cond Res. 2002;16(2):219–26.PubMed
28.
go back to reference Reed JA, Maslow AL, Long S, et al. Examining the impact of 45 minutes of daily physical education on cognitive ability, fitness performance, and body composition of African American youth. J Phys Act Health. 2013;10(2):185–97.CrossRefPubMed Reed JA, Maslow AL, Long S, et al. Examining the impact of 45 minutes of daily physical education on cognitive ability, fitness performance, and body composition of African American youth. J Phys Act Health. 2013;10(2):185–97.CrossRefPubMed
31.
go back to reference Schneider M, Dunton GF, Bassin S, et al. Impact of a school-based physical activity intervention on fitness and bone in adolescent females. J Phys Act Health. 2007;4(1):17–29.CrossRefPubMed Schneider M, Dunton GF, Bassin S, et al. Impact of a school-based physical activity intervention on fitness and bone in adolescent females. J Phys Act Health. 2007;4(1):17–29.CrossRefPubMed
33.
go back to reference Stock S, Miranda C, Evans S, et al. Healthy buddies: a novel, peer-led health promotion program for the prevention of obesity and eating disorders in children in elementary school. Pediatrics. 2007;120(4):e1059–68. doi:10.1542/peds.2006-3003.CrossRefPubMed Stock S, Miranda C, Evans S, et al. Healthy buddies: a novel, peer-led health promotion program for the prevention of obesity and eating disorders in children in elementary school. Pediatrics. 2007;120(4):e1059–68. doi:10.​1542/​peds.​2006-3003.CrossRefPubMed
34.
go back to reference Vandongen R, Jenner DA, Thompson C, et al. A controlled evaluation of a fitness and nutrition intervention program on cardiovascular health in 10- to 12-year-old children. Prev Med. 1995;24(1):9–22.CrossRefPubMed Vandongen R, Jenner DA, Thompson C, et al. A controlled evaluation of a fitness and nutrition intervention program on cardiovascular health in 10- to 12-year-old children. Prev Med. 1995;24(1):9–22.CrossRefPubMed
37.
go back to reference Kriemler S, Meyer U, Martin E, et al. Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Br J Sports Med. 2011;45(11):923–30. doi:10.1136/bjsports-2011-090186.CrossRefPubMed Kriemler S, Meyer U, Martin E, et al. Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Br J Sports Med. 2011;45(11):923–30. doi:10.​1136/​bjsports-2011-090186.CrossRefPubMed
38.
go back to reference Dobbins M, Husson H, DeCorby K, et al. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2013;2:CD007651. doi:10.1002/14651858.CD007651.pub2. Dobbins M, Husson H, DeCorby K, et al. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2013;2:CD007651. doi:10.​1002/​14651858.​CD007651.​pub2.
39.
go back to reference Vasconcellos F, Seabra A, Katzmarzyk PT, et al. Physical activity in overweight and obese adolescents: systematic review of the effects on physical fitness components and cardiovascular risk factors. Sports Med. 2014;44(8):1139–52. doi:10.1007/s40279-014-0193-7.CrossRefPubMed Vasconcellos F, Seabra A, Katzmarzyk PT, et al. Physical activity in overweight and obese adolescents: systematic review of the effects on physical fitness components and cardiovascular risk factors. Sports Med. 2014;44(8):1139–52. doi:10.​1007/​s40279-014-0193-7.CrossRefPubMed
40.
go back to reference Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5:4–85.CrossRefPubMed Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5:4–85.CrossRefPubMed
41.
go back to reference Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev. 2009;10(1):110–41. doi:10.1111/j.1467-789X.2008.00515.x.CrossRefPubMed Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev. 2009;10(1):110–41. doi:10.​1111/​j.​1467-789X.​2008.​00515.​x.CrossRefPubMed
43.
44.
go back to reference American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 9th ed. Philadelphia: American College of Sports Medicine; 2013. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 9th ed. Philadelphia: American College of Sports Medicine; 2013.
45.
go back to reference Committee on Fitness Measures and Health Outcomes in Youth. 5. Health-related fitness measures for youth: cardiorespiratory endurance. In: Pate R, Oria M, Pillsbury L, editors. Fitness measures and health outcomes in youth. Washington, DC: National Academies Press; 2012. Committee on Fitness Measures and Health Outcomes in Youth. 5. Health-related fitness measures for youth: cardiorespiratory endurance. In: Pate R, Oria M, Pillsbury L, editors. Fitness measures and health outcomes in youth. Washington, DC: National Academies Press; 2012.
46.
go back to reference Boreham CA, Paliczka VJ, Nichols AK. A comparison of the PWC170 and 20-MST tests of aerobic fitness in adolescent schoolchildren. J Sports Med Phys Fitn. 1990;30(1):19–23. Boreham CA, Paliczka VJ, Nichols AK. A comparison of the PWC170 and 20-MST tests of aerobic fitness in adolescent schoolchildren. J Sports Med Phys Fitn. 1990;30(1):19–23.
48.
go back to reference Dobbins M, De Corby K, Robeson P, et al. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6–18. Cochrane Database Syst Rev. 2009;21(1):CD007651. doi:10.1002/14651858.cd007651. Dobbins M, De Corby K, Robeson P, et al. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6–18. Cochrane Database Syst Rev. 2009;21(1):CD007651. doi:10.​1002/​14651858.​cd007651.
57.
go back to reference Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.0.2 (updated September 2009). Chapter 7.7.3.8. London: Cochrane Collaboration, 2009. Available from http://www.cochrane-handbook.org. Accessed 25 Jan 2016. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.0.2 (updated September 2009). Chapter 7.7.3.8. London: Cochrane Collaboration, 2009. Available from http://​www.​cochrane-handbook.​org. Accessed 25 Jan 2016.
58.
go back to reference Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988.
60.
go back to reference Hirst K, Baranowski T, DeBar L, et al. HEALTHY study rationale, design and methods: moderating risk of type 2 diabetes in multi-ethnic middle school students. Int J Obes. 2009;33(Suppl 4):S4–20. doi:10.1038/ijo.2009.112. Hirst K, Baranowski T, DeBar L, et al. HEALTHY study rationale, design and methods: moderating risk of type 2 diabetes in multi-ethnic middle school students. Int J Obes. 2009;33(Suppl 4):S4–20. doi:10.​1038/​ijo.​2009.​112.
64.
go back to reference Naylor PJ, Macdonald HM, Reed KE, et al. Action Schools! BC: a socioecological approach to modifying chronic disease risk factors in elementary school children. Prev Chronic Dis. 2006;3(2):A60.PubMedPubMedCentral Naylor PJ, Macdonald HM, Reed KE, et al. Action Schools! BC: a socioecological approach to modifying chronic disease risk factors in elementary school children. Prev Chronic Dis. 2006;3(2):A60.PubMedPubMedCentral
66.
go back to reference Sallis JF, McKenzie TL, Alcaraz JE, et al. The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, Play and Active Recreation for Kids. Am J Public Health. 1997;87(8):1328–34.CrossRefPubMedPubMedCentral Sallis JF, McKenzie TL, Alcaraz JE, et al. The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, Play and Active Recreation for Kids. Am J Public Health. 1997;87(8):1328–34.CrossRefPubMedPubMedCentral
67.
go back to reference Singh AS, Chin APMJ, Kremers SP, et al. Design of the Dutch Obesity Intervention in Teenagers (NRG-DOiT): systematic development, implementation and evaluation of a school-based intervention aimed at the prevention of excessive weight gain in adolescents. BMC Public Health. 2006;6(6):304. doi:10.1186/1471-2458-6-304.CrossRefPubMedPubMedCentral Singh AS, Chin APMJ, Kremers SP, et al. Design of the Dutch Obesity Intervention in Teenagers (NRG-DOiT): systematic development, implementation and evaluation of a school-based intervention aimed at the prevention of excessive weight gain in adolescents. BMC Public Health. 2006;6(6):304. doi:10.​1186/​1471-2458-6-304.CrossRefPubMedPubMedCentral
68.
go back to reference Gao Z. Motivated but not active: the dilemmas of incorporating interactive dance into gym class. J Phys Act Health. 2012;9(6):794–800.CrossRefPubMed Gao Z. Motivated but not active: the dilemmas of incorporating interactive dance into gym class. J Phys Act Health. 2012;9(6):794–800.CrossRefPubMed
70.
go back to reference Malina RM, Bouchard C, Bar-Or O. Growth, maturation and physical activity. 2nd ed. Champaign: Human Kinetics Books; 2004. Malina RM, Bouchard C, Bar-Or O. Growth, maturation and physical activity. 2nd ed. Champaign: Human Kinetics Books; 2004.
71.
go back to reference Malina RM, Katzmarzyk PT. Physical activity and fitness in an international growth standard for preadolescent and adolescent children. Food Nutr Bull. 2006;27(4 Suppl):S295–313.CrossRefPubMed Malina RM, Katzmarzyk PT. Physical activity and fitness in an international growth standard for preadolescent and adolescent children. Food Nutr Bull. 2006;27(4 Suppl):S295–313.CrossRefPubMed
72.
go back to reference Sherar LB, Esliger DW, Baxter-Jones AD, et al. Age and gender differences in youth physical activity: does physical maturity matter? Med Sci Sports Exerc. 2007;39(5):830–5.CrossRefPubMed Sherar LB, Esliger DW, Baxter-Jones AD, et al. Age and gender differences in youth physical activity: does physical maturity matter? Med Sci Sports Exerc. 2007;39(5):830–5.CrossRefPubMed
73.
go back to reference Rothman AJ. “Is there nothing more practical than a good theory?” Why innovations and advances in health behavior change will arise if interventions are used to test and refine theory. Int J Behav Nutr Phys Act. 2004;1(1):11.CrossRefPubMedPubMedCentral Rothman AJ. “Is there nothing more practical than a good theory?” Why innovations and advances in health behavior change will arise if interventions are used to test and refine theory. Int J Behav Nutr Phys Act. 2004;1(1):11.CrossRefPubMedPubMedCentral
74.
go back to reference Williams MA, Haskell WL, Ades PA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572–84. doi:10.1161/circulationaha.107.185214.CrossRefPubMed Williams MA, Haskell WL, Ades PA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572–84. doi:10.​1161/​circulationaha.​107.​185214.CrossRefPubMed
Metadata
Title
School-Based Interventions to Improve Cardiorespiratory Fitness in Adolescents: Systematic Review with Meta-analysis
Authors
Giseli Minatto
Valter Cordeiro Barbosa Filho
Juliane Berria
Edio Luiz Petroski
Publication date
01-09-2016
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 9/2016
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-016-0480-6

Other articles of this Issue 9/2016

Sports Medicine 9/2016 Go to the issue